I grant permission to University Hospitals Health System, Inc. ("UH"), its affiliates, employees and agents to use photographs/videos taken of me, on the date and at the location listed below, in publications (such as brochures, newsletters, magazines and new media [e.g., social media]), in electronic versions of the same publications, on display boards, on UH's website, in conjunction with other electronic media, and in non-UH publications, electronic or otherwise, without notifying me. I grant permission to UH to use my name and any other personally identifiable information in connection with such photographs/videos for a period up to 10 years.
I hereby waive any right to inspect or approve the finished photographs/videos or printed or electronic material that may be used in combination with the photographs/videos now or in the future, whether that use is known to me or unknown. I acknowledge and agree that this authorization is given without expectation of or any right to consideration or payment, present or future, and I waive any right to royalties or other compensation arising from or related to the use of the photograph/videos.
I hereby agree to hold harmless and forever release UH, its affiliates, agents and employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of a photograph/video wherein my likeness appears, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. I agree that if I am under the age of 18 or otherwise unable to contract on my own behalf, I will have a parent or guardian sign below.